CMS’s October Surprise: Will MA Plans for Low SES Get Meaningful Relief After All?

From: AIS Health

By James Gutman

In the course of less than a day and a half Oct. 19 and 20, CMS seemingly changed the entire mindset of many Medicare insurers serving highly disadvantaged populations from despair to cautious optimism. Its two top officials did that in separate presentations at a major industry conference that put a different interpretation on the results of new research it has conducted than did lower officials who unveiled the results of at least one piece of the new research at a Sept. 10 CMS conference. The change, as one top-level executive of a Medicare Advantage (MA) insurer put it at the later conference, was “pretty amazing.”

To understand the mood change, it’s first necessary to recall what happened Sept. 10. CMS then unveiled new research it had commissioned that found there were indeed differences in the star-ratings performance of regular Medicare Advantage beneficiaries versus those who were Medicare-Medicaid dual eligibles or low-income subsidy recipients. But CMS stars czar Elizabeth Goldstein, Ph.D., said then of the findings: “The impact is small for most measures, so overall the number of measures that might need change is small.” The characterization and conclusion led to reservations and pessimism expressed by MA plans serving low-socioeconomic status (SES) populations that they would get relief their plans needs from CMS.

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